-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, UiJVLyQxq5cN11aBsvHZHGOgeDycNk7E5sWn8redeo3jIV9ORFKIghXWZO5ZOreQ aAlad++168UOUNbkPzNk6A== 0001181431-04-034997.txt : 20040713 0001181431-04-034997.hdr.sgml : 20040713 20040713125742 ACCESSION NUMBER: 0001181431-04-034997 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040713 FILED AS OF DATE: 20040713 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BALSON ANDREW CENTRAL INDEX KEY: 0001212449 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32242 FILM NUMBER: 04911652 BUSINESS ADDRESS: STREET 1: BAIN CAPITAL PARTNERS LLC STREET 2: 111 HUNTINGTON AVE. CITY: BOSTON STATE: MA ZIP: 02199 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DOMINOS PIZZA INC CENTRAL INDEX KEY: 0001286681 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & RELATED PRODUCTS [5140] IRS NUMBER: 382511577 BUSINESS ADDRESS: STREET 1: 30 FRANK LLOYD WRIGHT DRIVE CITY: ANN ARBOR STATE: MI ZIP: 48106 MAIL ADDRESS: STREET 1: 30 FRANK LLOYD WRIGHT DRIVE CITY: ANN ARBOR STATE: MI ZIP: 48106 3 1 rrd46450.xml DOMINO'S PIZZA, INC. IPO X0202 3 2004-07-13 0 0001286681 DOMINOS PIZZA INC DPZ 0001212449 BALSON ANDREW C/O BAIN CAPITAL, LLC 600 MONTGOMERY STREET 33RD FLOOR SAN FRANCISCO CA 94111 1 0 1 0 Common Stock, $.01 par value 29116195 I See footnotes Andrew B. Balson is a member of Bain Capital Investors, LLC ("BCI"). BCI is the managing general partner of each of BCIP Associates II-B ("BCIP II-B") and BCIP Trust Associates II-B ("BCIP Trust II-B"). By vitue of this relationship, Mr. Balson may be deemed to share voting and dispositive power with respect to the 177,415 shares owned by BCIP II-B and the 54,373 shares owned by BCIP Trust II-B. BCI is the sole general partner of Bain Capital Partners VI, L.P. ("Partners VI") and Partners VI is the sole general partner of Bain Capital Fund VI, L.P. ("Fund VI") and Bain Capital VI Coinvestment Fund, L.P. ("Coinvest VI"). By viture of this relationship, Mr. Balson may be deemed to share voting and dispositive power with respect to the 11,818,847 shares held by Fund VI and the 13,452,988 shares held by Coinvest VI. BCI is attorney-in-fact for PEP Investments PTY Ltd. ("PEP"). By vitue of this relationship, Mr. Balson may be deemed to share voting and dispositive power with respect to the 39,390 shares owned by PEP. Mr. Balson is a member of Brookside Capital Management, LLC ("Brookside Management"). Brookside Management is the sole general partner of Brookside Capital Investors, L.P. ("Brookside Investors") and Brookside Investors is the sole general partner of Brookside Capital Partners Fund, L.P. ("Brookside Fund"). By viture of this relationship, Mr. Balson may be deemed to share voting and dispositive power with respect to the 2,596,046 shares owned by Brookside Fund. Mr. Balson is a member of Sankaty Investors, LLC ("Sankaty Investors"). Sankaty Investors is the sole managing member of Sankaty High Yield Asset Investors, LLC ("Sankaty High Yield Investors") and Sankaty High Yield Investors is the sole general partner of Sankaty High Yield Asset Partners, L.P. ("Sankaty Partners"). By viture of this relationship, Mr. Balson may be deemed to share voting and dispositive power with respect to the 977,136 shares owned by Sankaty Partners. Mr. Balson disclaims beneficial ownership of the securities held by each of the entities referred to in the foregoing footnotes except to the extent of his pecuniary interest therein. /s/ Andrew B. Balson 2004-07-13 -----END PRIVACY-ENHANCED MESSAGE-----